Which Exercise Works Best for Low Back Pain

Ben first lists limits of exercise comparison trials: many lack a control group, may not reflect whether people exercise in real life, encourage single-factor thinking, and often recruit sedentary people for whom any activity helps. A systematic review and meta-analysis found strength, resistance, coordination and stabilization exercise all reduced chronic low back pain compared with controls. A Scandinavian trial found high-load deadlift training no better than individualized low-load motor control exercise, with deadlifts better suited to people with lower pain and higher performance. In 52 sedentary patients, a walking program and a strengthening program both improved disability, fear avoidance and pain after six weeks. Pilates and stationary cycling also showed no difference. The mechanism behind these effects remains unknown. The take-home is that no exercise is clearly superior and the one that gets done matters most. Clinicians should ask what the person enjoys, what equipment and environment they have, and whether the program serves their functional goals.